Essential Gap Cover – Avoid Medical Shortfalls

Essential gap cover is a policy to cover you against medical shortfall costs and is provided by Essentialmed.

No South African medical aid scheme will cover 100% of all in and out of hospital fees as well as specialist charges.

There is always a limit to what they pay, and the difference between the actual cost and what the medical aid pays is known as the gap or shortfall.

Do not fear because Essential gap cover will take that worry away and cover you for the expenses not covered by the medical aid.

essential gap cover

Essential Gap Cover is Vital for Covering the Cost of Medical Shortfalls

What is Essential Gap Cover?

Essential gap cover is a policy that you take over and above your medical aid scheme to cover you for the shortfall between the expenses medical aids pay and the actual medical bill from the health care providers. These additional costs could be hospital fees, surgeons, anaesthetists, and specialist’s fees. These costs can significantly affect your savings.

Essential gap cover is available to members of any recognised medical aid. These medical aids include Momentum medical aid, Liberty medical aid and Discovery Health medical aid. Therefore, if you are a member of a member of medical aid, you will qualify for this additional cover.

Essential Gap Cover

Essential cover pays up to 400% of the medical aid rate. The plan will provide payment for the difference between what the healthcare providers charge and what the medical aid pays out.

Benefits of Medical Aid Schemes have Changed

Most of the medical aid plans in South Africa had made changes or adjustments to their policies. The medical aid schemes adjust and alter their benefits. That applies to many of the medical aids, including Momentum, Discovery and Liberty. Also, these adjustments could increase the shortfall and leave you expensive medical bills to try and pay if you do not have gap cover.

Essential Gap Cover

Some medical aid schemes had reduced their payout limits from 300% down to 200%. If the health care provider is charging 400%, for example, you could be left with crippling medical costs.

How does Gap Cover Protect You?

To explain how Essential Gap Cover works: First the claim is sent to your medical aid. They will process and pay according to their terms and conditions. Once this is complete, send the documents to Essential Gap Cover for them to handle the shortfall.

You will need to send the following:

  • Healthcare provider’s claims and invoices from your hospital treatment.
  • Statements from your medical aid detailing their payments.
  • And also a completed Essential Gap Cover claim form.

As soon Essential Gap Cover has received all the necessary paperwork, they will start to process the claim. Once the details have been verified, they will provide a statement of what shortfall costs they will cover. They will create a schedule for payment, and they will pay the money by eft. The claim process takes two weeks.

Is Shortfall Insurance Necessary?

Answer the following questions. If your answer is yes to one or more of the questions, it is advisable to investigate gap cover and request a quote.

  • Are you a member of a medical aid?
  • Is your existing health cover the only means you have of covering the financial costs of hospitalisation or specialist treatment?
  • Have you ever considered moving your medical aid package to a lower plan to save expenses?
  • Do you have concerns regarding the reduced benefits many medical aid companies are now offering?
  • Have you ever considered upgrading your medical aid plan to have increased cover?
  • In the event of the hospital admitting you, would you be able to raise the additional money that you require immediately?
  • Also, do you need peace of mind, knowing that if the hospital admits you, gap cover would be available to cover additional fees?

In conclusion, do not allow yourself to be burdened with excessive bills that were not provided for by your medical aid.

For a FREE gap cover quote simply enter your details into the form provided and click the GET A QUOTE button!

All info was correct at time of publishing